The agency also offers an alternative claim submission method.
Although the latest ICD-10 implementation date was proposed as Oct. 1, 2015, it wasn’t set in stone — until now. On July 31, CMS announced that the 2015 date has been finalized as the deadline for ICD-10 implementation. After Sept. 30, 2015, ICD-9 codes will no longer be accepted.
Because the date has already been pushed back several times, many providers are already prepared for the transition, but should continue to stay on top of ICD-10 changes and updates as the 2015 date gets closer.
Question: We recently finished our first internal audit and found a potential issue: One of the doctors told me that he only chooses level 99212 when it is a follow-up from a previous visit. He chooses levels 99213 and above for everything else. I do not believe it is that simple because I thought even if it was not a follow-up visit, something like a minor cold might warrant 99212. Can you advise?
North Dakota Subscriber
You can get extra points under ‘management options’ for new problems…if you know what they are.
When it comes to choosing the overall level of service for an evaluation and management encounter, such as an office visit, most coders will tell you that determining the medical decision making (MDM) complexity is the most complicated and difficult piece of the puzzle. Not only is the MDM a head-scratcher, but even the individual elements under it can be tough to navigate.
Such is the case when addressing a new problem, which can snag you more points than an established one. But many practices struggle to define what makes a new problem “new.” Fortunately, one MAC stepped in to clarify this issue last week.
Background: To determine the level of MDM, you should assign points to each of the three MDM components that your doctor performs.
When a problem is found during a well visit, you may need to charge patients who expect to pay nothing.
As you are well aware by now, the Patient Protection and Affordable Care Act (PPACA) that became law in 2010 requires you to provide preventive care visits consistent with Bright Futures Guidelines for children at no cost to the patient or family, including well child exams, vision and hearing screening, immunizations, and obesity counseling, among other services.
These visits are not subject to a copay, coinsurance or deductible, so patients who schedule them come to your practice expecting to leave without paying any money out of their pockets. However,
Tip: You’ll need to specify the joint and the side.
When a patient presents with a sprain of the wrist, this means the patient presents with an injury to the ligaments of the wrist.
Currently, you have these ICD-9 options:
- 842.00, Sprain of unspecified site of wrist
- 842.01, Sprain of carpal (joint) of wrist
- 842.02, Sprain of radiocarpal (joint)(ligament) of wrist
- 842.09, Other wrist sprain
ICD-10-CM: When ICD-10 hits, you’ll have numerous more options:
Question: Our physician did an SI injection in the office without any image guidance as the C-arm was not functioning. Should I bill 20552 or 20610?
Look out: Private lawsuits can be just as costly as federal HIPAA fines.
You might think you’re in the clear as long as you have a good grip on HIPAA requirements in your organization, but that may not always be the reality. A recent court case shows you could be held responsible for a business associate’s HIPAA violation.
Background: Led by former patient Shana Springer, Stanford Hospital & Clinics and two of its vendors faced a class action lawsuit for alleged privacy breaches of patients’ protected health information (PHI), violating California’s state privacy laws. The plaintiffs sought $20 million in damages, but the defendants recently settled the case for $4.1 million.
Multi-Specialty Collection Services (MSCS) was Stanford’s business associate (BA) and was named in the lawsuit, and then another BA contracting with MSCS, Corcino & Associates, was added to the complaint. The lawsuit alleged that Stanford and its BAs were responsible for disclosing the PHI of 20,000 emergency room patients. The BA had posted an Excel file online containing the PHI.
Because the BAs were at fault for the unpermitted disclosure, they will pay the majority of the settlement — about $3.3 million, reported attorney Elana Zana in a blog post for the Seattle-based law firm Ogden Murphy Wallace. But Stanford is still stuck paying out a whopping $500,000 toward a “vendor education fund” under the settlement agreement, as well as $250,000 in settlement administrative costs.
Why ‘No Fault’ Doesn’t Protect You
Find out whether you can report 99000 for handling of the specimen.
If your patient’s Pap smear results return as abnormal or display insufficient cells, the ob-gyn will probably perform a repeat smear. Use proper E/M coding to get the payment you deserve.
Zoom In on Your Visit Code
When the patient comes in for a second Pap smear, submit the appropriate E/M service. CPT® does not include a code for taking the Pap, so you should use the office visit code (99211-99215).
You will probably report 99212 for the Pap retest visit because the patient is here only for the Pap smear.
That translates to almost $45 per visit, using the Medicare Physician Fee Schedule national rate. Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) carries 1.22 relative value units (1.22 RVUs x 2008 conversion factor 35.8228 = $43.70).
Bill Collection Under These Criteria
The May 2014 CPT® Assistant starts off with a bang, featuring a 2014 code update article for four surgical areas: integumentary, respiratory, digestive, and urinary. Need to know what to do when the physician gets a specimen mammogram to verify calcification before the specimen heads to pathology? Want to be sure you’re reporting same-side pleural drainage and pleural catheter insertion correctly? See what the latest CPT® Assistant has to say.
You’ll find other 2014 updates in the May CPT® Assistant, too. You’ll also be able to prepare for coding beyond 2014 with helpful hints for ICD-10. Finding these articles is as simple as searching SuperCoder.com’s Code Connect by code and keyword:
- Abscess drainage, perirenal or renal: 10030, 49405-49407, 50020, 50021, 75989
- General surgery 2014 update: 10030, 13150-13153, 19081-19086, 19100, 19101, 19281-19288, 32550, 32554-32557, 32674, 38746, 50630, 51702, 52000, 52320, 52325, 52327, 52330, 52332, 52334, 52335, 52341-52346, 52351-52356
- ICD-10-CM code format
- Ophthalmology 2014 update: 12011, 12013-12018, 12051-12057, 13150-13153, 64612, 64613, 64616, 65778-65780, 66183, 67345, 67938, 68040, 92100, 92132, 92136, 92285, 0192T, 0207T, 0329T, 0330T
- Pediatric and neonatal care 2014 update: 36000, 36400, 36405, 36406, 36415, 36591, 36600, 43752, 43753, 71010, 71015, 71020, 92953, 93562, 94002, 94003, 94660, 94662, 94760-94762, 99090, 99221-99223, 99231-99233, 99291, 99292, 99466-99469, 99471, 99472, 99475-99482, 99485, 99486, 0260T, 0261T.
Question: Our patient was referred to home care following a cholecystectomy due to acute cholecystitis. She also has a history of breast cancer and is taking Tamoxifen prophylactically. She’s had some problems with urinary retention after surgery and one of her surgical wounds is dehisced. We will be discontinuing the indwelling catheter and instructing her on how to use an intermittent catheter. How should we code for this patient in ICD-9 and how will our coding change for ICD-10?
Answer: Code for this patient as follows,